wyork department teof of health · 27/3/2020 · 8. page n u mber of t he plan s e ction or...
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WYORK TEOF ORTUNITY
Department of Health
ANDREW M CUOMO Governor
HOWARD A ZUCKER MD JD Commissioner
SALLY DRESLIN MS RN Executive Deputy Commissioner
National Institutional Reimbursement Team Attention Mark Cooley CMS CMCS 7500 Security Boulevard MS S3-14-28 Baltimore MD 21244-1850
Dear Mr Cooley
RE SPA 20-0017 Long Term Care Facility Services
The State requests approval of the enclosed amendment 20-0017 to the Title XIX (Medicaid) State Plan for long term care facility services to be effective January 1 2020 (Appendix I) This amendment is being submitted based on enacted legislation A summary of the proposed amendment is provided in Appendix 11
This amendment is submitted pursuant to sect1902(a) of the Social Security Act (42 USC 1396a(a)) and Title 42 of the Code of Federal Regulations Part 447 Subpart C (42 CFR sect447)
A copy of the pertinent section of enacted legislation is enclosed for your information (Appendix Ill) Copies of the public notice of this proposed amendment which was given in the New York State Register on December 31 2019 is also enclosed for your information (Appendix IV) In addition responses to the five standard funding questions and standard access questions are also enclosed (Appendix V and VI respectively)
If you have any questions regarding this State Plan Amendment submission please do not hesitate to contact Regina Deyette Medicaid State Plan Coordinator Division of Finance and Rate Setting Office of Health Insurance Programs at (518) 473-3658
Enclosures cc Mr Ricardo Halligan
Sincerely
Donna Frescatore Medicaid Director Office of Health Insurance Programs
Empire State Plaza Corning Tower Albany NY 12237 I healthny gov
March 27 2020
e --lrffMENT f)F HEALrH ~ND HUMAN SERVICES N H$ f-OR MEOICAHt amp MEDICAID SERVICES
1 TRANSMITTAL NUMBER 2 STATE
t-OHM l)V~POVtf
()MB N t)_ d ~8 0 1 d
TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL
2 0 -0 0 1 7 New York
FOR CENTERS FOR MEDICARE amp MEDICAID SERVICES 3 PROGRAM IDENTIFICATION TITLE XIX OF THE SOCIAL
SECURITY ACT (MEDICAID) TITLE XIX OF THE SOCIAL SECURITY ACT (MEDICAID)
TO REGIONAL ADMINISTRATOR CENTERS FOR MEDICARE amp MEDICAID SERVICES
DEPARTMENT OF HEALTH AND HUMAN SERVICES
4 PROPOSED EFFECT IVE DATE
January 1 2020
5 TYPE OF PLAN MATERIAL Check One)
0 NEW STATE PLAN O AMENDMENT TO BE CONSIDERED AS NEW PLAN ~ AMENDMENT
COMPLETE BLOCKS 6 THAU 10 IF THIS IS AN AMENDMENT (Separate transmittal for each amendment)
6 FEDERAL STATUT EREGULATION CITATION 7 FEDERAL BUDGET IMPACT
middot middot a FFY 0110120-093020 sect 1902(a) of the Social Security Act and 42 CFR 447 b FFY 10101120 09130121
$ (1805771)
$ (2407695)
8 PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 9 PAGE NUMBER OF T HE SUPERSEDED PLAN SECTION
OR ATTACHMENT (If Applicable)
Attachment 419-D Part I Page A(i)
10 SUBJECT OF AMENDMENT
ATB-Long Term Care (FMAP=50)
11 GOVERNORS REVIEW (Check One)
~ GOVERNORS OFFICE REPORTED NO COMMENT 0 OTHER AS SPECIFIED
0 COMMENTS OF GOVERNORS OFFICE ENCLOSED
0 NO REPLY RECEIVED WITH IN 45 DAYS OF SUBMITTAL
16 RETURN TO
New York State Department of Health
--- -1 Division of Finance and Rate Setting
Donna Frescatore 99 Washington Ave - One Commerce Plaza
- - ---------- -----------1 Suite 1432 13 TY
14 TITLE Medicaid Director Department of Health
A lbany NY 12210
15 DATE SUBMITTED
17 DATE RECEIVED
FOR REGIONAL OFFICE USE ONLY
118 DATE APPROVED
PLAN APPROVED - ONE COPY ATTACHED
19 EFFECT IVE DATE OF APPROVED MATERIAL 20 SIGNATURE OF REGIONAL OFFICIAL
21 TYPED NAME 22 TITLE
23 REMARKS
FORM CMS- 179 (0792) Instructions on Back
March 27 2020
Appendix I 2020 Title XIX State Plan First Quarter Amendment
Amended SPA Pages
Attachment 419-D Part I
New York A(i)
1 Across-the-Board Reductions to Payments - Effective January 1 2020 and Thereafter (1) For dates of service on and after January 1 2020 the rates of reimbursement for Article 28
nursing homes will be adjusted to reflect an across the board reduction of one percent (1 )
a Sections subjected to the one percent (1 ) reduction are as follows
i Nursing Home Reimbursement Pages 110(d)(3) - 110(d)(20)
ii Specialty Care Facilities Page SO(g)(l)
TN_~~2=0~-~0=0=1~7_ ____ Approval Date _ _________ ___
Supersedes TN NEW Effective Date _________ _ _ _ _ _ _
Appendix II 2020 Title XIX State Plan First Quarter Amendment
Summary
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
e --lrffMENT f)F HEALrH ~ND HUMAN SERVICES N H$ f-OR MEOICAHt amp MEDICAID SERVICES
1 TRANSMITTAL NUMBER 2 STATE
t-OHM l)V~POVtf
()MB N t)_ d ~8 0 1 d
TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL
2 0 -0 0 1 7 New York
FOR CENTERS FOR MEDICARE amp MEDICAID SERVICES 3 PROGRAM IDENTIFICATION TITLE XIX OF THE SOCIAL
SECURITY ACT (MEDICAID) TITLE XIX OF THE SOCIAL SECURITY ACT (MEDICAID)
TO REGIONAL ADMINISTRATOR CENTERS FOR MEDICARE amp MEDICAID SERVICES
DEPARTMENT OF HEALTH AND HUMAN SERVICES
4 PROPOSED EFFECT IVE DATE
January 1 2020
5 TYPE OF PLAN MATERIAL Check One)
0 NEW STATE PLAN O AMENDMENT TO BE CONSIDERED AS NEW PLAN ~ AMENDMENT
COMPLETE BLOCKS 6 THAU 10 IF THIS IS AN AMENDMENT (Separate transmittal for each amendment)
6 FEDERAL STATUT EREGULATION CITATION 7 FEDERAL BUDGET IMPACT
middot middot a FFY 0110120-093020 sect 1902(a) of the Social Security Act and 42 CFR 447 b FFY 10101120 09130121
$ (1805771)
$ (2407695)
8 PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 9 PAGE NUMBER OF T HE SUPERSEDED PLAN SECTION
OR ATTACHMENT (If Applicable)
Attachment 419-D Part I Page A(i)
10 SUBJECT OF AMENDMENT
ATB-Long Term Care (FMAP=50)
11 GOVERNORS REVIEW (Check One)
~ GOVERNORS OFFICE REPORTED NO COMMENT 0 OTHER AS SPECIFIED
0 COMMENTS OF GOVERNORS OFFICE ENCLOSED
0 NO REPLY RECEIVED WITH IN 45 DAYS OF SUBMITTAL
16 RETURN TO
New York State Department of Health
--- -1 Division of Finance and Rate Setting
Donna Frescatore 99 Washington Ave - One Commerce Plaza
- - ---------- -----------1 Suite 1432 13 TY
14 TITLE Medicaid Director Department of Health
A lbany NY 12210
15 DATE SUBMITTED
17 DATE RECEIVED
FOR REGIONAL OFFICE USE ONLY
118 DATE APPROVED
PLAN APPROVED - ONE COPY ATTACHED
19 EFFECT IVE DATE OF APPROVED MATERIAL 20 SIGNATURE OF REGIONAL OFFICIAL
21 TYPED NAME 22 TITLE
23 REMARKS
FORM CMS- 179 (0792) Instructions on Back
March 27 2020
Appendix I 2020 Title XIX State Plan First Quarter Amendment
Amended SPA Pages
Attachment 419-D Part I
New York A(i)
1 Across-the-Board Reductions to Payments - Effective January 1 2020 and Thereafter (1) For dates of service on and after January 1 2020 the rates of reimbursement for Article 28
nursing homes will be adjusted to reflect an across the board reduction of one percent (1 )
a Sections subjected to the one percent (1 ) reduction are as follows
i Nursing Home Reimbursement Pages 110(d)(3) - 110(d)(20)
ii Specialty Care Facilities Page SO(g)(l)
TN_~~2=0~-~0=0=1~7_ ____ Approval Date _ _________ ___
Supersedes TN NEW Effective Date _________ _ _ _ _ _ _
Appendix II 2020 Title XIX State Plan First Quarter Amendment
Summary
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Appendix I 2020 Title XIX State Plan First Quarter Amendment
Amended SPA Pages
Attachment 419-D Part I
New York A(i)
1 Across-the-Board Reductions to Payments - Effective January 1 2020 and Thereafter (1) For dates of service on and after January 1 2020 the rates of reimbursement for Article 28
nursing homes will be adjusted to reflect an across the board reduction of one percent (1 )
a Sections subjected to the one percent (1 ) reduction are as follows
i Nursing Home Reimbursement Pages 110(d)(3) - 110(d)(20)
ii Specialty Care Facilities Page SO(g)(l)
TN_~~2=0~-~0=0=1~7_ ____ Approval Date _ _________ ___
Supersedes TN NEW Effective Date _________ _ _ _ _ _ _
Appendix II 2020 Title XIX State Plan First Quarter Amendment
Summary
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Attachment 419-D Part I
New York A(i)
1 Across-the-Board Reductions to Payments - Effective January 1 2020 and Thereafter (1) For dates of service on and after January 1 2020 the rates of reimbursement for Article 28
nursing homes will be adjusted to reflect an across the board reduction of one percent (1 )
a Sections subjected to the one percent (1 ) reduction are as follows
i Nursing Home Reimbursement Pages 110(d)(3) - 110(d)(20)
ii Specialty Care Facilities Page SO(g)(l)
TN_~~2=0~-~0=0=1~7_ ____ Approval Date _ _________ ___
Supersedes TN NEW Effective Date _________ _ _ _ _ _ _
Appendix II 2020 Title XIX State Plan First Quarter Amendment
Summary
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Appendix II 2020 Title XIX State Plan First Quarter Amendment
Summary
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
SUMMARY SPA 20-0017
This State Plan Amendment proposes to apply a 1 reduction uniformly across most long term care payments made under the States Long Term Care State Plan section 419-0 effective January 1 2020 and thereafter
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Appendix III 2020 Title XIX State Plan First Quarter Amendment
Authorizing Provisions
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
SPA 20- 0017
Chapter 53 of the Laws of 2019 201920 Appropriation Bill (S1503-D I A2003-D) Aid to Localities Budget Bill
Notwit hstanding and provis i on of l a w to the con trary t he director of the budget i n cons ultation with the commissioner of health may use a payment reduclion plan to make across - t he-board reductions to the department of health state funds medicaid spending by $190 200 000 for each of the state fiscal years 2019-2020 and 2020-2021 to limit such spending to the aggregate limits specified herein or reduce the aggregate limits specified herein to provide a reduction to the State s Finanshycial Plan Reductions shall be made in a manner that complies with t he state medishycaid plan approved by the federal centers fo r medicare and medicaid services provided however t hat the commissioner of health is aut horized to s ubmit ~ny state plan amendme nt or seek other federal approval to implement the p r ovisions of the medicaid payment reduc t ion p l an
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Appendix IV 2020 Title XIX State Plan First Quarter Amendment
Public Notice
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
MISCELLANEOUS NOTICESHEARINGS
Notice of Abandoned Property Received by the State Comptroller
Pursuant to provisions of the Abandoned Property Law and related laws the Office of the State Comptroller receives unclaimed monies and other property deemed abandoned A list of the names and last known addresses of the entitled owners of this abandoned property is maintained by the office in accordance with Section 1401 of the Abandoned Property Law Interested parties may inquire if they apshypear on the Abandoned Property Listing by contacting lhc Office of Uncla imed Funds Monday through Friday from 800 am to 430 pm at
1-800-221-93 l I or visit our web site al
wwwoscstate nyus Claims for abandoned property must be filed with the New York
State Comptrollers Office of Unclaimed Funds as provided in Section 1406 of the Abandoned Property Law For further information contact Office of the State Comptroller O ffice of Unclaimed Funds I l OState St Albany NY l 2236
PUBLIC NOTICE Department of Health
Pursuant to 42 CFR Sect ion 447205 the Department of Health hereby gives public notice of the following
The Department of Health p roposes to amend the Title XIX (Medicaid) Stale Plan fo r institutional non-institutional and long term care services to comply with proposed statutory provisions The folshylowing changes are proposed
All Services Effective for dates of service on or after January l 2020 through
March 3 1 2020 and each State Fiscal Year thereafter all non-exempt Department of Health state funds Medicaid payments will be unishyformly reduced by 10 Medicaid payments that will be exempted from the uniform reduction include
Payments based on federal law prohibitions inc lude but arc not limited to the following
bull Federally Qualified Health Center services bull Indian Health Services and services provided to Native Amerishy
cans bull Supplemental Medical Insurance - Part A and Part B bull State Contribut ion for Prescription Drug Benefi t (aka Medicare
Pnrt D payments) bull Any local share cap payment required by the Federal Medical Asshy
sistance Percentage (FMAP) increase legislation bull Required payments re lated to the School Supportive Health Ser-
vices Program and Preschool Supportive Health Services Program
bull Services provided to American citizen repatriates bull Payments pursuant to the mental hygiene law bull Court orders and judgments and
bull Hospice Services Payments funded exclusively w ith federal andor local funds
include but are not limited 10 the following
bull Upper payment limit payments to non-state owned or operated governmenta l providers certified under Article 28 of the NYS Public Health Law
bull Certified public expenditure payments to the NYC Health and Hospital Corporation
bull Certain disproportionate share payments to non-state operated or owned governmental hospitals
bull Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 20 IO and
bull Services provided to inmates of local correctional faci lities Payments where applying the reduction would result in a lower
FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt
The estimated annual net aggregate decrease in gross Medicaid expenditures attributable to this initiative contained in the budget for State Fiscal Year 20 I 9-20 is ($ 124000000) and ($496000000) for each State Fiscal Year thereafter
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovrcgulations statc_plansstatus Individua ls without Internet access may view the State Plan Amendments at any local (county) social services district
For the New York City district copies will be avai lable at the fol-lowing places
New York County 250 Church Street New York New York I 0018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11201
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and IO review and commenl please contact Depurtmcnt of Health D ivis ion of Finance and Rate Setting 99 Washington Ave One Commerce P laza Suite 1432 Albany NY 122 I 0 e-mail spa_ inquirieshealthnygov
PUBLIC NOTICE Depnrtment o f Health
Pursuant to 42 CFR Section 447205 the Department of Health hereby gives public notice of the fo llowing
101
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Miscellaneous NoticesHearings NYS RegisterDecember 31 2019
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for all qualifying Mental Hygiene services to comply with enacted statutory provisions The following changes are proposed
Long Term Care Effective on or after January I 2020 the State will change the
methods and standards for determining payment rates for a ll qualifyshying Mental Hygiene Services to provide funding to support a two percent increase in annual salary and salary-related fringe benefits to direct care staff and direct support professionals
Effective on or after April l 2020 a new two percent increase in annual salary and salary-re lated fringe benefits will he applied to direct cu-e staff direct support professionals and clinical staff for all qualifyshying Me ntal Hygiene Services For the purposes of the January I and April I 2020 funding increases direct support professionals are individuals employed in consolidated fisca l reporting position title codes ranging from 100 to 199 direct care staff are individuals employed in consolidated fiscal reporting position title codes ranging from 200 to 299 and clinical s taff are individuals employed in consolidated fiscal reporting position title codes ranging from 300 to 399
The estimated annual net aggregate increase in gross Medicaid exshypenditure attributable to this initiative enacted into law as part of the budget for SFY 20192020 is $ 140 million
The public is invited to review and comment on this proposed State Plan Amendment a copy of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus Individuals without Internet access may view the State Plan Amendments at any local (county) social serv ices district
For the New York City district copies will be available at the fo lshylowing places
New York County 250 Church Street New York New York 10018
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 1110I
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 I 6 Monterey Avenue Bronx New York 10457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York l0301
Forfurther information and to review and comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (518) 474- 1673 Fax (518) 473-8825 spa_inquirieshealthstatcnyus
PUBLIC NOTICE Department of Hea lth
Pursuant to 42 CFR Section 447205 the De partment of Health hereby g ives public notice of the following
The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to revise provishysions of the Ambulatory Patient Group (APG) reimbursement methodshyo logy and Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees The following changes arc proposed
Non-Institutional For the effective period January I 2020 through December 3 I
2020 the Ambulatory Patient Group (APG) reimbursement methodolshyogy is extended
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
Effective on or after January I 2020 the Ambulatory Patient Group (APG) reimbursement methodology is revised to include recalculated weight and component updates
The estimated annual net aggregate increase in gross Medicaid expenditures attributable to this initiative is $387 million
Effective on or after January I 2020 the [ndepende nt Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) fees are revised
The estimated ann ual ne t aggregate increase in gross Medicaid expenditures attributable to this initiative is $0
The public is invited to review and comment on this proposed State Plan Amendment Copies of which will be available for public review on the Departments website at httpwwwhealthnygovregulations state_plansstatus
Copies of the proposed State Plan Amendments will be on file in each local (county) social services district a nd available for public review
For the New York City district copies will be available at the folshylowing places
Ne w York County 250 C hurch Street New York New York LOOI 8
Queens County Queens Center 3220 Northern Boulevard Long Island City New York 11101
Kings County Fulton Center 114 Willoughby Street Brooklyn New York 11 20 I
Bronx County Tremont Center 19 16 Monterey Avenue Bronx New York I 0457
Richmond County Richmond Center 95 Central Avenue St George Staten Island New York I 030 I
Forfurther information and to review und comment please contact Department of Health Bureau of Federal Relations amp Provider Asshysessments 99 Washington Ave One Commerce Plaza Suite 1430 Albany NY 12210 (5 18) 474- I673 Fax (5 I 8) 473-8825 spa_inquirieshealthstatenyus
PUBLIC NOTICE Nassau County
The Deferred Compensation Plan for Employees of Nassau Health Care Corporation (the Plan) a 457(b) plan created under the laws of the State of New York and pursuant to Section 457(b) of the Internal Revenue Code is seeking proposals from qualified firms to
Provide consulting services to the Plan regarding monitoring the performance of the current plan record keeperadministrative service agent investment manager and trustee and overall plan investment performance
Proposals will be accepted until 4 00 pm on Monday February I 0 2020
A copy ofthe Request for Proposals may be obtained during normal business hours (900 a 111 to 500 p 111 - Weekdays) from Richard
102
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
AppendixV 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Funding Questions
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
APPENDIXV lONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Funding Questions (NIRT Standard Funding Questions)
The following questions are being asked and should be answered in relation to all payments made to ail providers under Attachment 419-D of the state plan
1 Section 1903a)(1) provides that Federal matching funds are only available for expenditures made by States for services under the approved State plan Do providers receive and retain the total Medicaid expenditures claamed by the State (includes normal per diem supplemental enhanced payments other) or is any portion of the payments returned to the State local governmental entity or any other intermediary organization lf providers are required to return any portion of payments please provide a full description of the repayment process Include in your response a full description of the methodology for the return of any of the amount or percentage of payments that are returned and the disposition and use of the funds once they are returned to the State (ie general fund medical services account etc)
Response Providers do retain the payments made pursuant to this amendment However this requirement in no way prohibits the public provider including county providers from reimbursing the sponsoring local government for appropriate expenses incurred by the local government on behalf of the public provider The State does not regulate the financial relationships that exist between public health care providers and their sponsoring governments which are extremely varied and complex Loca l governments may provide direct andor indirect monetary subsidies to their public providers to cover on-going unreimbursed operational expenses and assure achievement of their mission as primary safety net providers Examples of appropriate expenses may include payments to the local government which include reimbursement for debt service paid on a providers behalf reimbursement for Medicare Part B premiums paid for a providers retirees reimbursement for contractually required health benefit fund payments made on a providers behalf and payment for overhead expenses as allocated per federal Office of Management and Budget Circular 2 CFR 200 regarding Cost Principles for State Local and I ndian Tribal Governments The existence of such transfers should in no way negate the legitimacy of these facilities Medicaid payments or result in reduced Medicaid federal financial participation for the State This position was further supported by CMS in review and approval of SPA 07-07C when an on-site audit of these transactions for New York Citys Health and Hospitals Corporation was completed with satisfactory results
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
2 Section 1902(a)2) provides that the lack of adequate funds from local sources will not result in lowering the amount duration scope or quality of care and services available under the plan Please describe how the state share of each type of Medicaid payment (normal per diem supplemental enhanced other) is funded Please describe whether the state share is from appropriations from the legislature to the Medicaid agency through intergovernmental transfer agreements (IGTs) certified public expenditures (CPEs) provider taxes or any other mechanism used by the state to provide state share Note that if the appropriation is not to the Medicaid agency the source of the state share would necessarily be derived through either an XGT or CPE In this case please identify the agency to which the funds are appropriated Please provide an estimate of total expenditure and State share amounts for each type of Medicaid payment If any of the non-federal share is being provided using IGTs or CPfs please fully describe the matching arrangement including when the state agency receives the transferred amounts from the local government entity transferring the funds If CPEs are used please describe the methodology used by the state to verify that the total expenditures being certified are eligible for F~deral matching funds in accordance with 42 CFR 433Sl(b) For any payment funded by CPEs or IGTs please provide the following
(i) a complete list of the names of entities transferring or certifying funds
(ii) the operational nature of the entity (state county city other)
(iii) the total amounts transferred or certified by each entity (iv) clarify whether the certifying or transferring entity has
general taxing authority and (v) whether the certifying or transferring entity received
appropriations (identify level of appropriations)
Response Payments made t o service providers under the provisions of this SPA are funded through a general appropriation received by the State agency that oversees medica l assistance (Medicaid) which is the Department of Health
The source of the appropriat ion is the Medicaid General Fund Local Assistance Account which is part of the Global Cap The Global Cap is funded by General Fund and HCRA resources
There have been no new provider taxes and no existing taxes have been modified
3 Section 1902(a)(30) requires that payments for services be consistent with efficiency economy and quality of care Section 1903(a)(1) provides for Federal financial participation to States for expenditures for services under an approved State plan If supplemental or enhanced payments are made please provide the total amount for
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
each type of supplemental or enhanced payment made to each provider type
Response The payments authorized for this provision are not supplemental or enhanced payments
4 Please provide a detailed description of the methodology used by the state to estimate the upper payment limit (UPL) for each class of providers State owned or operated non-state government owned or operated and privately owned or operated) Please provide a current (ie applicabie to the current rate year) LIPL demonstration Under regulations at 42 CFR 447272 States are prohibited from setting payment rates for Medicaid inpatient services that exceed a reasonable estimate of the amount that would be paid under M2dkare payment principals
Response The State and CMS are working toward completing and approval of current year UPL
5 Does any governmental provider receive payments that in the aggregate (normal per diem supplemental enhanced other) exceed their reasonable costs of providing services If payments exceed the cost of services do you recoup the excess and return the Federal share of the excess to CMS on the quarterly expenditure report
Response Effective January 1 2012 the rate methodology included in the approved State Plan for non-specialty nursing facility services for the operating component of the rate is a blended statewidepeer group price adjusted for case mix and wage equalization factor (WEF) Specialty nursing facility and units are paid the operating rate in effect on January 1 2009 The capital component of the rate for all specialty and non-specialty faci lities is based upon a cost based methodology We are unaware of any requirement under current federal aw or regulation that limits individual provider payments to their actual costs
ACA Assurances
1 Maintenance of Effort (MOE) Under section 1902(99) of the Social Security Act (the Act) as amended by the Affordable Care Act as a condition of receiving ffiY_Federal payments under the Medicaid program during the MOE period indicated below the State shall not have in effect any eligibility standards methodologies or procedures in its Medicaid program which are more restrictive than such eligibility provisions as in effect in its Medicaid program on March 10 2010
MOE Period bull Begins on March 10 2010 and
Ends on The date the Secretary of the Federal Department of Health and Human Services determines m Exchange established by a State
11
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
under the provisions of section 1311 of the Affordable Care Act is fuly operational
Response This SPA complies with the conditions of the MOE provision of section 1902(gg) of the Act for continued funding under the Medicaid program
2 Section 1905(y) and (z) of-the Act provides for increased FMAPs tor expenditures made on or after January 1 2014 for individuals determined eligible under section 1902(a)(10)(A)(i)(VIII) of the Act Under section 1905(cc) of the Act the increased FMAP under sections 1905(y) and (z) would not be available for States that require local political subdivisions to contribute amounts toward the non-Federal share of the States expenditures at cl greater percentage than would have been required on December 31 2009
Prior to January 1 2014 States may potentially require contributions by local political subdivisions toward the non-Federal share of the States expenditures at percentages greater than were required on December 31 2009 However because of the provisions of section 1905(cc) of the Act it is important to determine and documentflag any SPAsState plans which have such greater percentages prior to the January 1 2014 date in order to anticipate potential violations andor almQllriate corrective actions by the States and the Federal government
Response This SPA would [ ] would not [ ] violate these provisions if t hey remained in effect on or after January 1 2015
3 Please indicate whether the State is currently in conformance with the requirements of section 1902a)(37) of the Act regarding prompt payment of claims
Response The State does comply with the requirements of section 1902(a)(37) of the Act regarding prompt payment of claims
Tribal Assurance
Section 1902(a)(73 of the Social Security Act the Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establisll a process for the State Medicaid agency to seek advice on a rnguiar ongoing basis from designees of Indian health programs whether operaterl by the In~ian Health Se1vice HIS Tribes or Tribal organizations under the Indian Self Determination and Education Assistance Act ISDEAA or Urban Indian Organizations under the Indian Health Care Improvement Act
IHCIA Section 2107(e)I) of the Act was also amended to apply these requirements to the Childrens Health Insurance Program CHIP
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Consultation is required concerning Medicaid and CHIP matters having a direct impact on Indian health programs and Urban Indian organizations
a) Please describe the process the State uses to seek advice on a regular ongoing basis from federally recognized tribes Indian Health Programs and Urhan Indian Organizations on matters related to Medicaid and CHIP programs and for consultation on State Plan Amendments waiver proposals waiver extensions wcliver amendments waiver renewals and proposals for demonstration projects prior to submission to CMS
b) Please include information about the frequency inclusiveness and process for seeking such advice
c) Please describe the consultation process that occurred specifically for the development and submission of this State Plan Amendment when it occurred and who was involved
Response Tribal consultation was performed in accordance with the States t ribal consultation policy as approved in SPA 17-0065 and documentation of such is included with the original submission To date no feedback has been received from any tribal representative in response to the proposed change in this SPA
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
Appendix VI 2020 Title XIX State Plan First Quarter Amendment
Responses to Standard Access Questions
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
APPENDIX VI LONG TERM CARE SERVICES
State Plan Amendment 20-0017
CMS Standard Access Questions
The following questions have been asked by CMS and are answered by the State in relation to all payments made to all providers under Attachment 419-D of the state plan
1 Specifically how did the State determine that the Medicaid provider payments that will result from the change in this amendment are sufficient to comply with the requirements of 1902(a(30
Response This amendment seeks to apply a one percent (1 ) reduction uniformly across most long-term care payments made under the States Long Term Care State Plan section 419-D effective January 1 2020 and thereafter While this is a reduction in reimbursement it reflects a minimal change for providers and is being uniformly applied so there will be no major impacts to the payments made for provision of services
2 How does the State intend to monitor the impact of the new rates and implement a remedy should rates be insufficient to guarantee required access levels
Response The State has various ways to ensure that access levels in the Medicaid program are retained and is currently not aware of any access issues Certain classes of providers must notify and receive approval from the Departments Office of Primary Care and Health Systems Management in order to discontinue services These offices monitor and consider such requests in the context of access as they approvedeny changes in services Finally providers cannot discriminate based on source of payment
For providers that are not subject to an approval process the State will continue to monitor provider complaint hotlines to identify geographic areas of concern andor service type needs If Medicaid beneficiaries begin to encounter access issues the Department would expect to see a marked increase in complaints These complaints will be identified and analyzed in light of the changes proposed in this State Plan Amendment
Finally the State ensures that there is sufficient provider capacity for Medicaid Managed Care plans as part of its process to approve managed care rates and plans Should access to services be compromised the State would be alerted and would take appropriate action to ensure retention of access to such services
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population
3 How were providers advocates and beneficiaries engaged in the discussion around rate modifications What were their concerns and how did the State address these concerns
Response This change was enacted by the State Legislature as part of the negotiation of the 2019-20 Budget The impact of this change was weighed in the context of the overall Budget in the State The legislative process provides opportunities for all stakeholders to lobby their concerns objections or support for various legislative initiatives In addition NY published notice in the state register of the proposed policy and did not receive any comments
4 What action(s does the State plan to implement after the rate change takes place to counter any decrease to access if the rate decrease is found to prevent sufficient access to care
Response Should any essential community provider experience Medicaid or other revenue issues that would prevent access to needed community services per usual practice the State would meet with them to explore the situation and discuss possible solutions if necessary
5 Is the State modifying anything else in the State Plan which will counterbalance any impact on access that may be caused by the decrease in rates ( eg increasing scope of services that other provider types may provide or providing care in other settings
Response The State continues to implement Medicaid reform initiatives to better align reimbursement and to ensure access to quality of care in the appropriate setting The State updates nursing home rates twice a year to support changes in patient acuity which ensures appropriate payment for the needs of individuals in care The recently approved 15 nursing home rate increase will help assist facilities whose rates are negatively impacted by this change The State is also continuing the 1 supplemental increase that goes to all nursing homes Finally the State offers other programs to nursing homes such as the Vital Access Provider (VAP) program and the Nursing Home Quality Pool (NHQI) to help sustain key health care services While some of these initiatives are outside the scope of the State Plan they represent some of the measures the State is taking to ensure quality care for the States most vulnerable population